No New Funding for Program That Pairs Psychiatrists, Pediatricians

At least one out of every five children is suffering from mental health issues that could result in problems ranging from trouble in school to serious depression to suicide. But only one in nine of these youngsters is properly diagnosed and effectively treated, experts have found.

The problem is complex, but stems in large part from the traditional disconnect between pediatricians who treat a child’s physical symptoms and mental health providers. Two years ago the state launched a pilot program to help bridge this divide and physicians involved said it has already helped more than 600 children; it is now being built out to reach youngsters in eight counties in southern and central New Jersey.

Despite this initial success – and a growing level of funding from Gov. Chris Christie in the past – supporters were disappointed to learn there was no money included in the coming year’s budget for the Primary Care Child Psychiatry collaboration. The program received $1.2 million in the FY2015 budget and Christie included $2.4 million in the current year, an increase that came as a pleasant surprise to those involved.

“Our children are more at risk for fragmented care than ever,” explained Dr. Fran Gallagher, who leads the New Jersey Chapter of the American Academy of Pediatrics. “The preliminary data is clearly pointing to what we hoped it would point to” -- that more children are getting screened, diagnosed, and treated for mental health issues, she said. “To pull the plug prematurely would be a great mistake.”

“The whole program falls apart if there’s not continuity and funding,” added Dr. Stephen Kairys, a pediatrician affiliated with Meridian Health, which operates the program in several counties. “And it’s small dollars compared to the number the number of kids it helps.”

There is a growing awareness in the healthcare industry of the critical need to better integrate physical and behavioral care. This is particularly important with children, experts said, since half of the adults who suffer from mental illness developed symptoms before age 14 and suicide is the leading cause of death for youngsters between 10 and 24 years old.

Those involved said the collaborative program succeeded by helping pediatricians, who are often the first and only doctor many children see regularly, identify mental health issues early, and connect these kids and their families with quality treatment. It also required doctors to follow up to make sure the family received the care they needed.

“For the first time we have mental health and primary care talking to each other,” Kairys said. “The whole system has been a mess for a long time. It’s a real disaster, especially for kids. Mental health is just a huge black box.”

The collaboration helps address the historical stigma that surrounds mental health issues by training pediatricians on the prevalence of the disease, to identify the symptoms and work with patients to better understand their emotional needs, providers involved said. It also connects them with an on-call psychiatrist who can provide real-time consultations on diagnoses, medications, and doses. And if a patient needs more specialized psychiatric care, the program schedules them an appointment -- sometimes within 24 hours.

“These are kids that probably would have fallen through the cracks otherwise,” explained Dr. Ramon Solhkah, also with Meridian Health.

The program pays for the pediatricians’ time to learn how to identify signs of mental illness and funds a psychiatrist for on-call consultations, in-person appointments, and follow-up care. It is open to families regardless of their insurance or ability to pay, and there is no additional cost to the patient. By identifying mental health issues early, there is a far better chance of providing effective treatment that can help the child avoid more serious problems down the road, experts said.

Given the acute shortage of psychiatrists, especially those who treat children and teens, it can otherwise take six weeks to three months for a youngster to get a mental health appointment, the physicians said. “We recognize there is a workforce shortage,” explained Dr. Debra Koss, a child and adolescent psychiatrist who leads the New Jersey Psychiatric Association. “But we also need to address the immediate needs of these children.”

The governor’s office referred questions on the program and the funding to the Department of Children and Families, which oversees the program. Ernest Landante, a DCF spokesman, said funding in the current budget will carry it through spring 2017; the contract with doctors funded by the current budget expires in April.

“Next year, we'll analyze data collected from the pilot to determine if it fits with the department’s long-term strategic goals,” Landante said; he declined to elaborate on what the state is looking to determine.

The lack of funding has also raised concerns for Sen. Robert Gordon (D-Bergen), who initially championed the concept and tried to get a pilot program implemented through the Legislature -- before the governor decided to fund it on his own. “But this year the money disappeared” Gordon said.

“What we’re doing now is to lobby the leadership of both houses,” he said, “and to see if we can get this money restored as a budget resolution.” Feedback from Democratic leaders has been positive so far, he said. “We’ll continue to make that pitch.”

In addition, physicians involved in the program suggest the data quest is a bit of a red herring, at this point. Because of the contract cycle with the doctors and the months it took to build the program, the real work is just beginning. And, so far, hundreds of children have been referred for additional treatments.

“If they don’t continue the program we can’t get the data,” Solhkah said. “At least continue the project, so it’s enough to demonstrate the usefulness.”

Results from other states also show it is effective over time, supporters said. Programs in Massachusetts and Washington State “now provide us with enough data to know this is an effective model,” Koons said. “But this is not a one-size fits-all approach. The models need to be tweaked and adjusted within the state to specifically target the needs of youth in New Jersey.”

The program started in two hubs: one that operated in Monmouth and Ocean counties, run by Meridian Health Care, and another in Camden and Burlington counties overseen by Cooper University Health Care. The additional funding in fiscal year 2016 allowed it to begin expansion into other southern counties and parts of central New Jersey. Covering the full state would require between $5 million and $6 million, they said.

“It comes back to importance of not only continuing the current pilot but also extending it statewide,” Koss said. “If the pilot ends then them momentum of all the work that’s been done in the last two years would come to a halt.”